University of Penn-Dental Med Asst

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD028425E Issued in PA

Legal business name

UNIVERSITY OF PENN-DENTAL MED ASST

Practice address

3400 Civic Center Blvd
1 East Pavilion
Philadelphia, PA 19104-5127

Phone

(215) 662-2450

NPI assigned

Dec 19, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gary W Crooks

Title

MD

Phone

(215) 662-2450

Specialties & licenses 1

Addresses

Other names 1

• Penn Personalized Care Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1324252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325721600000",
    "number": "1598034639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "address_2": "1 EAST PAVILION",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045127",
            "telephone_number": "215-662-2450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "address_2": "1 EAST PAVILION",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045127",
            "telephone_number": "215-662-2450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF PENN-DENTAL MED ASST",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-19",
        "last_updated": "2012-01-05",
        "status": "A",
        "authorized_official_last_name": "CROOKS",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "215-662-2450"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD028425E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Penn Personalized Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• University of Penn Chop Dental
• University of Penn OB/GYN
• University of Penn Psychiatry
• University of Penn-Anesthesia
• University of Penn-Anesthesia
• University of Penn-Medical Group
• University of Penn-Medical Group
• University of Penn-Medical Group
• University of Penn-Medical Group
• University of Penn-Medical Group

• Internal Medicine Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Internal Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.